Improving Depression Screening in Primary Care

Abstract

Background: Depression is a serious problem in the United States. It not only impacts chronic illness and healthcare utilization, but it can also result in death, intentional or unintentional.Despite the seriousness associated with depression, it continues to be underdiagnosed and undertreated. The primary care setting provides an ideal location to screen and initiate treatment for depression in individuals who would otherwise not be screened.

Objective: The objective of this evidence-based practice project was to improve the diagnosis and treatment of depression in an adult primary care office.

Method: An intervention consisting of a HealthWatcher reminder for depression screening, the administration of the PHQ-9 instrument, and a treatment algorithm was incorporated into the office workflow. The charts of a pre-intervention random sample were compared to a post-intervention random sample to test for significant differences in depression screening and treatment rates.

Results: Using the chi-squared test, the post-intervention sample screening rate was significantly higher than pre-intervention sample rate (90% vs 23.3%; χ² = 54.3, df = 1, P < .000).

Conclusion/implications: It is feasible to improve the diagnosis and treatment of depression for adult primary care patients by modifying office protocols and using the PHQ-9 screening instrument and a treatment algorithm.

Keywords: Patient Health Questionnaire (PHQ-9); electronic health record (EHR); integrated alert; screening for depression.